Home Health & Hospice Week

If you want your rightful reimbursement for a newly resolved Medicare claims system glitch, you’ll need to submit an adjustment for it.

Problem: “Home health claims were not receiving the low comorbidity adjustment for claims with COVID-19 diagnosis code U07.1,” HHH Medicare Administrator Palmetto GBA says on its website. “Code U07.1 corresponds to the clinical grouping Medication Management, Teaching and Assessment (MMTA), Respiratory, and receives the low comorbidity adjustment.”

Solution: “This issue has been resolved. Home health claims are now receiving the low comorbidity adjustment for claims with COVID-19 diagnosis code U07.1,” Palmetto reports. But to correct the problem, “providers may submit adjustments for claims with diagnosis code U07.1 that did not receive the low comorbidity adjustment,” the MAC instructs. “Providers shall use the D9 condition code and enter remarks stating, ‘Adjusting to receive low comorbidity adjustment for claim with COVID-19 diagnosis code U07.1 as identified on the [Claims Processing Issues Log].’”

Instructions for how to deal with timely filing problems for the issue are at https://palmettogba.com/palmetto/jmhhh.nsf/DID/E19QJ1970G.